A littoral cell angioma (LCA) is a rare benign vascular tumor of the spleen. A 60-year-old man, with multiple nodules in imaging study and liver cirrhosis graded as Child-Pugh classification class A, was transferred for splenomegaly. A thrombocytopenia was found on hematological evaluation. Because there was no evidence of hematological and visceral malignancy, a splenectomy was performed for a definitive diagnosis. The histological and immunohistochemical features of the splenic specimens were consistent with a LCA. After the splenectomy, the thrombocytopenia recovered to the normal platelet count. There has been no previous report of a LCA combined with liver cirrhosis. Herein, the first case of a LCA in Korea, diagnosed and treated by a splenectomy, is reported.
Hemangioma/*complications/pathology/surgery ; Humans ; Liver Cirrhosis/*complications/pathology ; Male ; Middle Aged ; Splenectomy ; Splenic Neoplasms/*complications/pathology/surgery

Gastrointestinal stromal tumor (GIST) represents the most common intramural mesenchymal tumor of the gastrointestinal tract, but the synchronous occurrence of GIST in the stomach and gynecological cancer is rare. We present a unique case of a 56-year-old female patient who was diagnosed with the synchronous development of GIST and an isolated parenchymal splenic metastasis of ovarian cancer. She underwent a wide local excision of gastric lesions with splenectomy. A morphological (histological and immunohistochemical) study established a spindle-cell type of gastrointestinal tumor that expressed CD117, and a parenchymal recurrence of ovarian papillary serous adenocarcinoma. The patient has remained alive and disease-free for 30 months since the last operation. A small GIST concomitant with an isolated parenchymal splenic metastasis of ovarian cancer is rarely encountered. The coexistence of GIST with other malignancies constitutes an intriguing oncologic model. Surgeons are advised to be alert against possible primary GIST accompanying other neoplasms.
Female ; Gastrointestinal Stromal Tumors ; diagnostic imaging ; secondary ; Humans ; Middle Aged ; Ovarian Neoplasms ; complications ; Radiography ; Splenic Neoplasms ; secondary

PURPOSE: The preservation or removal of the spleen during a total gastrectomy has been greatly debated. We analyzed early results of a prospective randomized trial of 146 patients with gastric cancer who underwent a total gastrectomy to evaluate the impact of a combined splenectomy on the postoperative course. METHODS: Patients were randomized intraoperatively using a computer-generated random number table to remove the spleen versus preservation of the spleen. RESULTS: There were 73 patients in the preservation group and 73 in the splenectomy group. There was one patient in the preservation group who died of postoperative complication. There were two deaths in the splenectomy group. After a splenectomy 27% of the patients experienced postoperative complications versus 25% in the preservation group. Preservation of the spleen showed improved overall survival as compared to a splenectomy, but this difference was not statistically significant. For patients with curative resections, the 3-year survival tended to be higher after preservation of the spleen (0.7146 versus 0.5203; p=0.1038). Improvement in survival was not statistically significant for subgroups of patients with metastatic lymph nodes at the hilum of the spleen (p=0.9303), and in subgroups of patients with metastatic lymph nodes along the splenic artery (p= 0.8681). CONCLUSION: Survival benefit with or without preservation ofthe spleen during total gastrectomy in patients with gastric cancer will be clarified on continued follow-up.
Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Postoperative Complications ; Prospective Studies* ; Spleen ; Splenectomy* ; Splenic Artery ; Stomach Neoplasms*

PURPOSE: A pancreas-preserving total gastrectomy (PPTG) was introduced to decrease the postoperative complications due to pancreatic resection. However, some complications, such as leakage of pancreatic juice, are still reported. Thus, the purpose of this study was to propose a supplementary procedure based on the results of treatment for gastric cancer at our hospital. MATERIALS AND METHODS: From Jan. 1997 to Dec. 2004, the cases of 141 patients who underwent a PPTG for gastric cancer were reviewed retrospectively. The patients were divided into Group A (38 cases), patients who were treated using a conventional PPTG, and Group B (103 cases), patients who were treated using a new and improved PPTG. Their postoperative complications were compared. RESULTS: No statistically significant differences in clinicopathologic data were noted between the two groups. The comparison of complications showed for groups A and B, respectively, 4 and 0 cases of pancreatic fistula, 1 and 0 cases of intraabdominal abscess, 2 and 0 cases of intraoperative pancreatic necrosis, and 2 and 2 cases of minor leakage. The difference in the prevalence of complications between the two groups was statistically significant (P=0.0001). CONCLUSION: In order to reduce the risk of PPTG-related complications, we used vascular clamps to observe the necrosis of the pancreatic tail before dividing the splenic artery, and this method resulted in a significant decrease in postoperative complications. Thus, we conclude that our use of vascular clamps in a PPTG is a simple and useful method for preventing postoperative complications.
Abscess ; Gastrectomy* ; Humans ; Necrosis ; Pancreatic Fistula ; Pancreatic Juice ; Postoperative Complications ; Prevalence ; Retrospective Studies ; Splenic Artery ; Stomach Neoplasms

OBJECTIVETo investigate the clinical manifestations, pathologic features and laboratory findings in two Proteus syndrome patients with giant hemangiomas in the spleen and chronic DIC.

METHODSUltrasound imaging and magnetic resonance imaging (MRI) were used for analysing the characteristics of the giant hemangiomas in the spleen. The spleen specimen was examined pathologically for the feature of the hemangioma. Homostatic tests were performed by routine laboratory methods.

RESULTSTwo Proteus syndrome patients with giant hemangiomas in the spleen causing chronic DIC (Kasabach-Merritt syndrome) were first reported. They were recovered after splenectomy.

CONCLUSIONProteus syndrome when accompanied giant hemangioma could cause chronic DIC. Significantly decreased plasma fibrinogen level in this case might be helpful for the differential diagnosis from DIC caused by other diseases.

Adolescent ; Disseminated Intravascular Coagulation ; etiology ; Female ; Hemangioma, Cavernous ; complications ; diagnostic imaging ; surgery ; Humans ; Proteus Syndrome ; complications ; Splenectomy ; Splenic Neoplasms ; complications ; diagnostic imaging ; surgery ; Ultrasonography

We report a case of pathological splenic rupture as a manifestation of malignant metastatic spindle cell tumour. To the best of our knowledge, this is the first case report of an atraumatic-pathological rupture of the spleen secondary to metastatic malignant spindle cell tumour. A 63-year-old man with a previous history of right upper limb amputation for an axillary malignant spindle cell tumour was admitted with an acute abdomen. Computed tomography showed a ruptured spleen. The patient subsequently underwent splenectomy. Histopathology confirmed the presence of malignant metastatic spindle cell tumour. Pathological splenic rupture is a rare manifestation of metastatic malignant spindle cell tumour. Background oncological history and thorough examination of the musculoskeletal system may provide important clues to make a prompt diagnosis.
Humans ; Male ; Middle Aged ; Rupture, Spontaneous ; diagnostic imaging ; etiology ; Sarcoma ; complications ; diagnostic imaging ; pathology ; Spleen ; diagnostic imaging ; pathology ; Splenectomy ; Splenic Neoplasms ; complications ; diagnostic imaging ; pathology ; Splenic Rupture ; diagnostic imaging ; etiology ; Tomography, X-Ray Computed

While T-cell non-Hodgkin's lymphoma (NHL) associated with hemophagocytic syndrome (HPS) has been frequently observed, B-cell NHL associated with HPS has been rarely reported. We report a case of hepatosplenic B-cell lymphoma associated with HPS in a 41-year-old woman who presented with fever of unknown origin. An abdominal CT scan revealed splenomegaly with focal splenic infarction. Splenectomy and a liver wedge biopsy showed sinusoidal-pattern infiltration of medium to large tumor cells with positive reaction to a B-lymphocyte marker. Findings on bone marrow examination showed proliferation of histiocytes with avid hemophagocytosis.
Adult ; Antigens, CD/analysis ; Antineoplastic Agents, Combined/therapeutic use ; Bone Marrow Cells/pathology ; Case Report ; Female ; Histiocytosis, Non-Langerhans-Cell/pathology ; Histiocytosis, Non-Langerhans-Cell/complications* ; Human ; Liver Neoplasms/radiography ; Liver Neoplasms/pathology ; Liver Neoplasms/complications* ; Lymphoma, B-Cell/radiography ; Lymphoma, B-Cell/pathology ; Lymphoma, B-Cell/complications* ; Splenic Neoplasms/radiography ; Splenic Neoplasms/pathology ; Splenic Neoplasms/complications* ; Splenomegaly/radiography ; Tomography, X-Ray Computed ; Tumor Markers, Biological/analysis

PURPOSE: A distal pancreatectomy was often simultaneously performed with splenectomy and total gastrectomy in the treatment of gastric carcinoma for complete removal of lymph nodes around the splenic artery. However, pancreatic juice leakage, subphrenic abscess, and postoperative diabetes were common complications in patients treated by pancreas resection. We performed a retrospective analysis to evaluate the role of distal pancreatectomy on the prognosis of gastric cancer patients. MATERIALS AND METHODS: The effect of distal pancreatectomy on survival was studied by examination of the records of 120 patients who underwent splenectomy and total gastrectomy for gastric carcinoma with serosal invasion. Of these, 75 underwent pancreas preserving splenectomy and 45 underwent pancreaticosplenectomy. Prognostic factors and postoperative complications were evaluated according to the operation types. RESULTS: The addition of distal pancreatectomy to splenectomy with total gastrectomy for patients with gastric cancer was not associated with severe complications. And patients underwent pancreaticosplenectomy showed similar survival as those underwent pancreas preserving splenectomy. CONCLUSION: Distal pancreatectomy for the gastric cancer patients with suspected metastatic lymph nodes around the splenic artery could be recommended for the purpose of radical lymph node dissection.
Gastrectomy* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Pancreas ; Pancreatectomy* ; Pancreatic Juice ; Postoperative Complications ; Prognosis* ; Retrospective Studies ; Splenectomy ; Splenic Artery ; Stomach Neoplasms* ; Subphrenic Abscess

OBJECTIVE: Distal pancreatectomy with splenectomy may be required for optimal cytoreductive surgery in patients with epithelial ovarian cancer (EOC) metastasized to splenic hilum. This study evaluates the morbidity and treatment outcomes of the uncommon procedure in the management of advanced or recurrent EOC. METHODS: This study recruited 18 patients who underwent distal pancreatectomy with splenectomy during cytoreductive surgery of EOC. Their clinicopathological characteristics and follow-up data were retrospectively analyzed. RESULTS: All tumors were confirmed as high-grade serous carcinomas. The median diameter of metastatic tumors located in splenic hilum was 3.5 cm (range, 1 to 10 cm). Optimal cytoreduction was achieved in all patients. Eight patients (44.4%) suffered from postoperative complications. The morbidity associated with distal pancreatectomy and splenectomy included pancreatic leakage (22.2%), encapsulated effusion in the left upper quadrant (11.1%), intra-abdominal infection (11.1%), pleural effusion with or without pulmonary atelectasis (11.1%), intestinal obstruction (5.6%), pneumonia (5.6%), postoperative hemorrhage (5.6%), and pancreatic pseudocyst (5.6%). There was no perioperative mortality. The majority of complications were treated successfully with conservative management. During the median follow-up duration of 25 months, nine patients experienced recurrence, and three patients died of the disease. The 2-year progression-free survival and overall survival were 40.2% and 84.8%, respectively. CONCLUSION: The inclusion of distal pancreatectomy with splenectomy as part of cytoreduction for the management of ovarian cancer was associated with high morbidity; however, the majority of complications could be managed with conservative therapy.
Adult ; Aged ; *Cytoreduction Surgical Procedures ; Disease-Free Survival ; Female ; Humans ; Middle Aged ; Neoplasms, Glandular and Epithelial/mortality/pathology/*surgery ; Ovarian Neoplasms/mortality/pathology/*surgery ; *Pancreatectomy/adverse effects ; Postoperative Complications/epidemiology/therapy ; *Splenectomy/adverse effects ; Splenic Neoplasms/pathology/*secondary/*surgery

OBJECTIVETo study the clinical value of radical resection of gastric carcinoma with pancreas and spleen preservation (PSP) and functional cleaning of lymph nodes (LNs) of the spleen hillus and along the splenic artery.

METHODSPancreas and spleen involvement was retrospectively reviewed among 439 cases of resectable carcinoma of the gastric cardia, gastric corpus and total stomach. During gastric surgery, 2 ml of methylene blue was injected into the subserosal space of the gastric cardia or corpus to observe the spread of lymphatic flow in 54 cases of gastric carcinoma. The metastatic rate of LNs in splenic hillus and along the trunk of the splenic artery (No10, No11), postoperative complications and survival rates were investigated in 63 gastric carcinoma patients that had received gastrectomy with pancreas and spleen preservation (PSP). These were compared with the pancreas preservation (PP) group and pancreas and spleen combined resection (PSR) group.

RESULTSAmong these 439 cases, only 25 cases were observed with direct invasion to the pancreas (5.7%), and 10 cases with direct invasion to the spleen (2.3%). After pathological examination of the pancreatic body and tail, we found 22 cases with pancreas and spleen combined resection, 4 cases (18.2%, 4/22) with direct invasion of the capsule and 2 with invasion to the superficial parenchyma (9.1%, 2/22), without metastasis to the lymph nodes within the pancreas and spleen. The metastatic rate of No10, No11 lymph nodes were 17.5% (11/63) and 19.1% (12/63) in the PSP group, 20.8% (45/216) and 25% (54/216) in the PP group, and 20% (6/30) and 23.3% (7/30) in the PSR group. There were no statistically significant differences (P > 0.05). Injection of methylene blue into the subserosal space of the stomach did not diffuse into the spleen or pancreatic parenchyma. Postoperative complications, diabetes and mortality in PSP (0%, 0%, 0%) were lower than in PP (4.2%, 0.9%, 0.9%) or PSR (40%, 10%, 3.3%). The 5-year survival rate (5-YSR) and 10-YSR in PSP (57.5%, 52.0%) were higher than in PSR (37.5%, 30.0%). Those patients with stage II and III(a) treated by PSP, improved markedly.

CONCLUSIONSThe surgical procedure of pancreas and spleen preservation for gastric cancer is a safe and organ function protected method. Postoperative complications were lower and survival rates were higher, the radicality was not reduced. These results indicate that PSP is preferred in patients with gastric carcinoma of stage II or III(a).

Adult ; Aged ; Female ; Humans ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Lymphatic System ; physiopathology ; Male ; Methylene Blue ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms ; secondary ; surgery ; Postoperative Complications ; Splenic Neoplasms ; secondary ; surgery ; Stomach Neoplasms ; mortality ; pathology ; surgery ; Survival Rate ; Treatment Outcome